| NPI | 1821773573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405258) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: NY 712808) |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-12-18 |